What does this research mean for the field?

Levosimendan infusion improves right ventricular hemodynamic performance, including right ventricular cardiac power index and pulmonary vascular resistance, in patients with cardiogenic shock following acute myocardial infarction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the hemodynamic effects of levosimendan on right and left ventricular function in patients experiencing refractory cardiogenic shock following acute myocardial infarction.

November 18, 2009Critical Care Medicine

Right ventricular function in myocardial infarction complicated by cardiogenic shock: Improvement with levosimendan*

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Why the study?

Does levosimendan improve right ventricular hemodynamic performance in patients with intractable cardiogenic shock following myocardial infarction?

Population

25 consecutive patients with intractable cardiogenic shock due to myocardial infarction who had not improved…

Design

Cohort

Follow-up

24 hours

Authors

MRMartin RußHumboldt-Universität zu Berlin RPRoland ProndzinskyHeart Failure & Transplant JCJustin M. CarterJohannes Gutenberg University Mainz

Discussion

Member takes

Implication

Was associated with improved RV hemodynamics in refractory post-MI shock; leaves open need for randomized outcome trials.

Key Points

To evaluate the hemodynamic effects of levosimendan on right and left ventricular function in patients experiencing refractory cardiogenic shock following acute myocardial infarction.
Conducted an observational hemodynamic study in a tertiary university hospital involving 56 patients with post-myocardial infarction cardiogenic shock treated with revascularization and inotropes.
Administered 24-hour bail-out levosimendan infusion (12 µg/kg/min bolus for 10 min, then 0.1–0.2 µg/kg/min maintenance) to 25 patients failing conventional therapy while monitoring invasive hemodynamics.
Levosimendan increased cardiac index from 2.1 ± 0.1 to 3.0 ± 0.2 L·min⁻¹·m⁻² (p < .01) and right ventricular cardiac power index from 0.14 ± 0.19 to 0.18 ± 0.12 W (p < .001).
Pulmonary vascular resistance decreased from 227.7 ± 94.5 to 178.1 ± 62.3 dyne·s·cm⁻⁵ (p = .002), with sustained hemodynamic benefits post-infusion and no significant changes in central venous or mean pulmonary artery pressure.

Structured PICO

Does levosimendan improve right ventricular hemodynamic performance in patients with intractable cardiogenic shock following myocardial infarction?

Population

25 consecutive patients with intractable cardiogenic shock due to myocardial infarction who had not improved sufficiently with conventional therapy (including dobutamine and norepinephrine) after percutaneous revascularization.

Intervention

Levosimendan (bolus of 12 microg/kg per minute for 10 mins then 0.1 microg/kg per minute--0.2 mug/kg per minute) as 'bail-out' therapy for 24 hrs.

Outcome

Hemodynamic parameters of right ventricular performance (including right ventricular cardiac power index, pulmonary vascular resistance, and cardiac index) measured during 24 hours of therapy.surrogate

In patients with post-myocardial infarction cardiogenic shock refractory to conventional inotropes, bail-out levosimendan therapy significantly improves right ventricular hemodynamic performance.

Cite This Study

Ruß et al. (2009) studied this question.

synapsesocial.com/papers/6a1bd22f69a4af5b15a90de9 https://doi.org/10.1097/ccm.0b013e3181b0314a

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Right ventricular function in myocardial infarction complicated by cardiogenic shock: Improvement with levosimendan*

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Right ventricular function in myocardial infarction complicated by cardiogenic shock: Improvement with levosimendan*

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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